Serum Uric Acid Levels and Outcomes After Acute Ischemic Stroke

Overview

Journal Mol Neurobiol

Specialties Molecular Biology
Neurology

Date 2015 Mar 7

PMID 25744569

Citations 48

Authors

Zhongchao Wang

Yanlin Lin

Yuxiu Liu

Ying Chen

Bin Wang

Changgui Li

Shengli Yan

Yangang Wang

Wenjuan Zhao

Affiliations

Soon will be listed here.

Abstract

Previous studies assessing the association between serum uric acid levels and neurological outcome after acute ischemic stroke reported conflicting results. A systematic review and meta-analysis were conducted to assess the impact of serum uric acid levels on outcome after acute ischemic stroke. Pubmed, Embase, Web of Science, and Google scholar were searched through September 26, 2014 to identify eligible published or unpublished studies on the association between serum uric acid levels and outcome after acute ischemic stroke. Hazard ratio (HR) for poor outcome or mean differences of serum uric acid levels with 95% confidence intervals (95% CIs) were pooled using meta-analysis. The primary outcome was occurrence of poor outcomes, while the secondary outcome was the mean differences of serum uric acid levels in patients with good or poor outcomes. Ten eligible studies with a total of 8131 acute ischemic stroke patients were included into the meta-analysis. Compared with low serum uric acid level, high serum uric acid level was associated better outcome after acute ischemic stroke (HR = 0.77, 95% CI 0.68-0.88, P = 0.0001). Sensitivity analysis further identified the prognostic role of serum uric acid levels on outcome after acute ischemic stroke. Patients with good outcomes had a higher serum uric acid level compared with those with poor outcome (mean difference = 30.61 μmol/L, 95% CI 20.13-41.08, P < 0.00001). There was no obvious risk of publication bias in the meta-analysis. This meta-analysis supports that serum uric acid level has a protective effect on neurological outcome after acute ischemic stroke. High uric acid level at the onset is a biomarker of better prognosis in patients with acute ischemic stroke.

Citing Articles

Targeting uric acid: a promising intervention against oxidative stress and neuroinflammation in neurodegenerative diseases.

Xu L, Li C, Wan T, Sun X, Lin X, Yan D Cell Commun Signal. 2025; 23(1):4.

PMID: 39754256 PMC: 11699683. DOI: 10.1186/s12964-024-01965-4.

Association between uric acid and the risk of hemorrhagic transformation in patients with acute ischemic stroke: a systematic review and meta-analysis.

Qian Y, Li N, Li Y, Tao C, Liu Z, Zhang G Front Neurol. 2024; 15:1378912.

PMID: 39119562 PMC: 11306017. DOI: 10.3389/fneur.2024.1378912.

Serum uric acid as a predictor of mortality in patients with stroke: results from National Health and Nutrition Examination Survey 2007-2016.

Tong X, Lyu C, Guo M, Gu J, Zhao Y Front Neurol. 2024; 15:1383300.

PMID: 38988602 PMC: 11233759. DOI: 10.3389/fneur.2024.1383300.

Dual effects of serum urate on stroke risk and prognosis: insights from Mendelian randomization.

Chen S, Chen Z, Xu Q, Jiang X, Lin C, Ji J Front Neurol. 2024; 15:1359292.

PMID: 38628696 PMC: 11018999. DOI: 10.3389/fneur.2024.1359292.

Lower serum uric acid to serum creatinine ratio as a predictor of poor functional outcome after mechanical thrombectomy in acute ischaemic stroke.

Xu J, Jiang X, Liu Q, Liu J, Fang J, He L Eur J Neurol. 2024; 31(7):e16296.

PMID: 38588211 PMC: 11235666. DOI: 10.1111/ene.16296.

References

Cherubini A, Polidori M, Bregnocchi M, Pezzuto S, Cecchetti R, Ingegni T . Antioxidant profile and early outcome in stroke patients. Stroke. 2000; 31(10):2295-300. DOI: 10.1161/01.str.31.10.2295. View

Amaro S, Canovas D, Castellanos M, Gallego J, Marti-Febregas J, Segura T . The URICO-ICTUS study, a phase 3 study of combined treatment with uric acid and rtPA administered intravenously in acute ischaemic stroke patients within the first 4.5 h of onset of symptoms. Int J Stroke. 2010; 5(4):325-8. DOI: 10.1111/j.1747-4949.2010.00448.x. View

Romanos E, Planas A, Amaro S, Chamorro A . Uric acid reduces brain damage and improves the benefits of rt-PA in a rat model of thromboembolic stroke. J Cereb Blood Flow Metab. 2006; 27(1):14-20. DOI: 10.1038/sj.jcbfm.9600312. View

Yang N, Zhang B, Xie L, Yin J, He Y, Yang X . The association baseline NIH Stroke Scale score with ABO blood-subtypes in young patients with acute ischemic stroke. Atherosclerosis. 2014; 236(1):144-9. DOI: 10.1016/j.atherosclerosis.2014.06.019. View

Brouns R, Wauters A, Van de Vijver G, De Surgeloose D, Sheorajpanday R, De Deyn P . Decrease in uric acid in acute ischemic stroke correlates with stroke severity, evolution and outcome. Clin Chem Lab Med. 2009; 48(3):383-90. DOI: 10.1515/CCLM.2010.065. View

Grefkes C, Fink G . Connectivity-based approaches in stroke and recovery of function. Lancet Neurol. 2014; 13(2):206-16. DOI: 10.1016/S1474-4422(13)70264-3. View

Wu H, Jia Q, Liu G, Liu L, Pu Y, Zhao X . Decreased uric acid levels correlate with poor outcomes in acute ischemic stroke patients, but not in cerebral hemorrhage patients. J Stroke Cerebrovasc Dis. 2013; 23(3):469-75. DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.007. View

Gao C, Zhang B, Zhang W, Pu S, Yin J, Gao Q . Serum prealbumin (transthyretin) predict good outcome in young patients with cerebral infarction. Clin Exp Med. 2010; 11(1):49-54. DOI: 10.1007/s10238-010-0103-8. View

Dawson J, Lees K, Weir C, Quinn T, Ali M, Hennerici M . Baseline serum urate and 90-day functional outcomes following acute ischemic stroke. Cerebrovasc Dis. 2009; 28(2):202-3. DOI: 10.1159/000226580. View

10.

Lee S, Heo S, Kim J, Lee D, Lee J, Kim Y . Effects of uric acid levels on outcome in severe ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator. Eur Neurol. 2013; 71(3-4):132-9. DOI: 10.1159/000355020. View

11.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

12.

Maaijwee N, Rutten-Jacobs L, Schaapsmeerders P, van Dijk E, de Leeuw F . Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. 2014; 10(6):315-25. DOI: 10.1038/nrneurol.2014.72. View

13.

Newman E, Rahman F, Lees K, Weir C, Walters M . Elevated serum urate concentration independently predicts poor outcome following stroke in patients with diabetes. Diabetes Metab Res Rev. 2005; 22(1):79-82. DOI: 10.1002/dmrr.585. View

14.

Koton S, Howard S, Warlow C, Murphy M, Rothwell P . Serum urate predicts long-term risk of acute coronary events in women after a transient ischaemic attack and stroke. Cerebrovasc Dis. 2008; 26(5):517-24. DOI: 10.1159/000155990. View

15.

Amaro S, Urra X, Gomez-Choco M, Obach V, Cervera A, Vargas M . Uric acid levels are relevant in patients with stroke treated with thrombolysis. Stroke. 2010; 42(1 Suppl):S28-32. DOI: 10.1161/STROKEAHA.110.596528. View

16.

Zhang B, Gao C, Yang N, Zhang W, Song X, Yin J . Is elevated SUA associated with a worse outcome in young Chinese patients with acute cerebral ischemic stroke?. BMC Neurol. 2010; 10:82. PMC: 2949608. DOI: 10.1186/1471-2377-10-82. View

17.

Feigin V, Forouzanfar M, Krishnamurthi R, Mensah G, Connor M, Bennett D . Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383(9913):245-54. PMC: 4181600. DOI: 10.1016/s0140-6736(13)61953-4. View

18.

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

19.

Zhang X, Zhang J, Peng Y, Xu Y, Zhang Y . [Association between serum uric acid and short-term clinical outcome among patients with acute stroke]. Zhonghua Liu Xing Bing Xue Za Zhi. 2012; 33(5):529-33. View

20.

Karagiannis A, Mikhailidis D, Tziomalos K, Sileli M, Savvatianos S, Kakafika A . Serum uric acid as an independent predictor of early death after acute stroke. Circ J. 2007; 71(7):1120-7. DOI: 10.1253/circj.71.1120. View